Master of Public Health Thesis and Capstone PresentationsCopyright (c) 2015 Thomas Jefferson University All rights reserved.http://jdc.jefferson.edu/mphcapstone_presentation
Recent documents in Master of Public Health Thesis and Capstone Presentationsen-usFri, 13 Feb 2015 10:37:31 PST3600The Impact of Psychosocial Stress on Sexual Risk Behaviors Among Gay, Bisexual and Questioning Male Adolescentshttp://jdc.jefferson.edu/mphcapstone_presentation/133
http://jdc.jefferson.edu/mphcapstone_presentation/133Thu, 11 Dec 2014 11:07:41 PST
Compared to heterosexuals, adolescents that identify as gay, bisexual or questioning (GBQ) experience a higher prevalence of mental illness related to psychological and social stress. GBQ adolescent males also account for the largest proportion of new HIV infections among youth. The purpose of this Capstone project is to examine how a higher level of psychosocial stress among GBQ male adolescents predicts sexual risk behaviors, thus contributing to the incidence of HIV/sexually transmitted disease (STD). Data analysis of the 2011 New York City Youth Risk Behavior Survey (YRBS) was conducted to compare the level of psychosocial stress and sexual risk behaviors between GBQ and heterosexual male adolescents. Next, the relationship between psychosocial stress and sexual risk behaviors among GBQ male adolescents was assessed using general linear models. Dichotomous survey items measuring depressed mood, suicidality, and victimization were used to assess psychosocial stress. Sexual risk behaviors included multiple sexual partners, condom nonuse, and alcohol/drug use during intercourse. All indicators of psychosocial stress were found to be higher among GBQ male adolescents compared to heterosexual male adolescents. GBQ male adolescent were also more likely to recently pursue risky sexual behaviors. Finally, depressed mood, suicidality and victimization were found to significantly predict the likelihood of sexual risk behaviors, and all psychosocial variables predicted alcohol/drug use during recent intercourse. Therefore, mental health should be an essential component of HIV/STD prevention efforts to effectively change the sexual risk behaviors of GBQ adolescents. It is recommended that public health interventions target primary care physicians and enact mandatory training in how to appropriately identify and manage psychosocial stress among GBQ adolescents. Additionally, anti-bullying policy in schools should be reformed to specifically protect sexual minorities against the psychosocial stress of anti-GBQ victimization.

Presentation: 23 minutes

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Joshua MilberAccrual Barriers in Cancer Clinical Trials: A Strategy Assessmenthttp://jdc.jefferson.edu/mphcapstone_presentation/132
http://jdc.jefferson.edu/mphcapstone_presentation/132Thu, 11 Dec 2014 11:01:24 PST
In the United States, 1.2 million Americans are diagnosed with cancer annually and only 2.5% of adult cancer patients are enrolled into clinical trials. The purpose of this research was to assess clinical trial recruitment strategies through key informant interviews with physicians and clinical trials coordinators (CTCs) to identify best practices and strategies for patient recruitment among National Cancer Institute (NCI)-designated cancer institutions. Findings were compared and contrasted among the selected cancer centers, as well as physicians and CTCs, in order to provide a recommendation for a comprehensive approach to clinical trial recruitment. One physician and one CTC were identified and interviewed at eight selected NCI-designated institutions. Interviewees were asked how their patients become aware and learn about available clinical trials, barriers faced by patients and physicians, potential strategies for the elimination of barriers, and the recruitment of underrepresented populations. A qualitative analysis was performed using a thematic, descriptive approach. This research found most patients learn about available clinical trials through their medical oncologist and the Internet. Patient barriers included: transportation, time, cost, lack of knowledge and understanding about clinical trials. Physician barriers included: time, regulatory requirements, logistical challenges, and cultural/language barriers. Recruitment of underrepresented populations was not a priority at any of the institutions. Streamlining regulatory requirements, legislative mandates, and cultural competency training were suggested as ways to increase participation in trials. Various forms of marketing were used to promote awareness among patients such as posters, mailers, and community seminars. Based on this research, a recommendation for a comprehensive approach to cancer clinical trial recruitment would be to mandate, at a federal level, that insurance companies cover all patient costs associated with participating in a trial and institute, at a local level, a requirement that all physicians complete cultural competency training and maintain a presence within the community.

Presentation: 22 minutes

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Ariane VarlottaA Policy Analysis of Legislation Regulating Indoor Tanning Salonshttp://jdc.jefferson.edu/mphcapstone_presentation/131
http://jdc.jefferson.edu/mphcapstone_presentation/131Thu, 11 Dec 2014 10:56:31 PST
The worldwide incidence of skin cancer has dramatically increased over the last few decades and may be attributed to the increased use of tanning beds. The purpose of this study was to compare indoor tanning legislation around the world and within the United States to recommend the most feasible state legislation to decrease skin cancer rates associated with indoor tanning. GLOBOCAN 2012 was used to identify the ten countries worldwide with the highest incidence rate of melanoma. Eight states in the US were selected for analysis: six states with legislation regulating sunbed use and two local states without existing legislation. Data about each country’s and state’s legislation was organized in an Excel spreadsheet. Interviews with key national and international stakeholders in cancer-related organizations or public offices were conducted to identify challenges in advocating for legislation. Results showed that legislation varied extensively by country, with one country close to a complete ban on sunbed use, five countries with no legislation regulating sunbed use, and four countries with partial restrictions on sunbed use. Enforcement issues included a lack of resources to effectively monitor tanning facilities, particularly in countries with unstaffed sunbeds. Among the six US states with legislation, the state health department is most often responsible for monitoring compliance. Common themes from the stakeholder interviews included the importance of a strong coalition, debunking tanning bed myths, the need for enforcement, and the extensive amount of time required to pass legislation. The proposed state policy would ban those under age 18 from using a sunbed regardless of parental or physician consent. Additionally, all tanning facilities would register with the state and pay an annual fee based on the number of tanning beds in the facility. This fee would cover the costs associated with monitoring tanning facilities and enforcing the new state law.

Presentation: 22 minutes

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Yelena SpectorMedication Adherence in Oncology: The Role of Oral Anti-Cancer Drugs and Copaymentshttp://jdc.jefferson.edu/mphcapstone_presentation/130
http://jdc.jefferson.edu/mphcapstone_presentation/130Wed, 15 Oct 2014 11:19:52 PDT
Use of oral anti-cancer drugs has increased within the last five years and, with 25% of the cancer drugs in development administered orally (Giuseppe, 2010), it will continue to increase. Ten oncologists, five each from the United States and Australia, were interviewed to understand their views on the implications of the switch from IV to oral anti-cancer drugs, the role adherence and copayment play in their treatment decisions, and their use of adherence interventions. Relevant literature was analyzed and compared to the findings from the primary research. Most American and Australian physicians agreed that their use of orals had increased and would likely increase in the next five years. However, treatment decisions were driven by disease and standards of care, not by route of administration. These oncologists did not view adherence as a primary concern for patients on oral anti-cancer drugs. They reported high levels of perceived adherence, estimating that 55% to 100% of their patients were adherent to oral anti-cancer therapy, with no differences between the countries. The primary difference between American and Australian oncologists was the role of copayment on treatment decision. All Americans said patient copay was a significant factor in their treatment decision, whereas all Australians said it was not. In both countries, the oncologists had minimal experience with adherence interventions (other than basic patient education) and mixed receptivity to their usefulness. The overstated perceived adherence rates found in this study are documented in the literature, but they are not supported by actual adherence studies. Oncologists need to be educated on documented adherence rates for oral anti-cancer drugs so that they devote adequate time to educating patients on the importance of compliance and persistency. Additionally, the United States must consider the broad policy implications of its reimbursement system that makes copayment a primary factor in treatment choice.

Presentation: 28 minutes

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Tracy ElyInforming the Content Development of a Relationship Curriculum for teenagers with Trisomy 21: A survey of parents and healthcare professionalshttp://jdc.jefferson.edu/mphcapstone_presentation/129
http://jdc.jefferson.edu/mphcapstone_presentation/129Fri, 18 Jul 2014 13:01:50 PDT
The Trisomy 21 (T21) Program at Children’s Hospital of Philadelphia (CHOP) assessed the need and priorities for educational programming about relationships and sexual health for teens aged 12-17 with T21. REDCap software was used to collect anonymous electronic survey results from 49 parents (quantitative data) and from 7 healthcare professionals (qualitative data). Using SPSS statistical software, univariate frequencies were calculated for interactions between teens and their parents, providers, or schools. Chi-square analyses identified differences by gender, age, or having older siblings. Means and frequencies described parent preparedness and prioritized topics for a curriculum. Two independent reviewers identified themes and sub-themes from the qualitative data. Curricula topics were prioritized by tallying keywords. Parents and professionals agreed the most important topic to cover is personal skills. Overall, healthcare professionals feel parents are ill-prepared to discuss relationships with their child with T21. Parents self-reported a mean preparedness score of 51.89 (out of 100), indicating that most parents were not prepared to talk about relationships and sexual health with their teen. Being female or having older siblings increased the likelihood of parents initiating discussions about sexual health with their teen. Many professionals stated they do not discuss relationships and sexual health, which was confirmed by 85.4% of parents reporting their child’s provider has not discussed relationships or sexual health. As far as school inclusion in health education, only 39% of parents knew if their child would be included in school-based sex education, and only 25% of those parents thought their child would understand the information. Most professionals believe TV/media are teens’ primary information sources. To best help teens with T21 attain and maintain healthy relationships, the team should develop an educational program focused on building personal skills, providing parents with adequate resources, and ensuring that clinicians discuss relationships and sexual health with the teens.

Presentation: 20 minutes

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Kristy PalmerHotspotting: Using TJUH Data to Understand Super Utilizershttp://jdc.jefferson.edu/mphcapstone_presentation/128
http://jdc.jefferson.edu/mphcapstone_presentation/128Fri, 18 Jul 2014 13:01:48 PDT
Rising costs in healthcare and increasing volume in Emergency Departments (ED) have sparked interest in examining the most costly and most frequent users of the ED. This study uses data from Thomas Jefferson University Hospital and Jefferson Hospital for Neuroscience over a two-year period in order to better understand characteristics of superutilizers. Two separate groups of superutilizers were defined in this study: the top 5% most costly superutilizers and the top 5% most frequent users. Characteristics examined for each of these two groups include: gender, age, race, zip code, payer type, number of claims, length of stay, and emergency severity index. Each analysis compared the top 5% versus the bottom 95% for each group. Results were similar to previous research finding that superutilizers were most often older adults with more chronic conditions then non-superutilizers. This leads to the conclusion that superutilizers are less healthy adults who do require more healthcare than non-superutilizers. Future goals include developing and evaluate interventions that address the healthcare needs of these patients.

Presentation: 25 minutes

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Brittany DivitoThe Impact of Adverse Childhood Events on Super-Utilization in Camden, New Jerseyhttp://jdc.jefferson.edu/mphcapstone_presentation/127
http://jdc.jefferson.edu/mphcapstone_presentation/127Fri, 18 Jul 2014 12:56:57 PDT
The purpose of this mixed-methods study was to explore super utilizers’ perceptions of the influence of Adverse Childhood Experiences (ACEs) on their health and lives. This study additionally compared the super utilizers’ ACE scores to normative ACE data described in the literature. Eligible participants were medically and psychosocially complex patients who had completed the Camden Coalition’s Care Management intervention. 22 participants were enrolled in the study and interviewed in their homes in Camden, NJ. The survey included 9 ACE questions with follow up qualitative interview questions designed to elicit information about the impact of ACES on their lives. Participants’ ACE scores were compared to the general population’s ACE data. Interview transcripts were transcribed and content analysis conducted. The general population has an average ACE score of 1.4 while this super utilizer population had an average ACE score of 2.9. 9 out of 22 (41%) of super utilizers experienced at least 4 ACEs while only 12.5% of the general population has experienced 4 or more ACEs. In the 13 qualitative interviews, super utilizers who had an ACE score of 3 or higher all reported suffering from mental illness. Super utilizers appear to suffer from more ACEs on average than the general population. ACEs may predict high utilization of hospital services. Future mixed methods studies with super utilizers should be conducted with larger sample sizes to further investigate these findings.

Presentation: 23 minutes

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Brent TroyAssessment of the Utilization and Satisfaction of Educational Material in the Postpartum Weight Management Studyhttp://jdc.jefferson.edu/mphcapstone_presentation/126
http://jdc.jefferson.edu/mphcapstone_presentation/126Mon, 07 Jul 2014 11:01:02 PDT
Maternal obesity is a pervasive public health problem. The Postpartum Weight Management Study (PPWM Study) exemplifies a community-based participatory research study, bringing together Maternity Care Coalition (MCC) staff and researchers from the University of Pennsylvania. The project employs randomized control methodology to evaluate a low-cost, multi-component intervention consisting of motivational text messages, in-home physical activity aids, social support, and education delivered during a “6-week challenge” designed for weight loss. Printed educational materials containing nutrition and exercise information are administered and explained to the intervention group. This Capstone Project involves the assessment of the utility and satisfaction of the PPWM educational materials provided to the Study’s intervention cohort. The objectives of the educational material assessment are to determine participants’ utilization of, satisfaction with, and format preference for the educational materials provided as part of the PPWM intervention and to provide recommendations to the PPWM Study researchers on refining effective educational materials in the future based upon evaluation. Telephone interviews were conducted with thirty English-speaking mothers participating in the intervention cohort. Both quantitative and qualitative questions were asked to assess three main domains—participants’ utilization, satisfaction, and format preference. The analyzed data revealed that the majority of the PPWM Study participants were satisfied with and read the educational materials daily. They preferred the materials with the most illustrations and wanted both paper and electronic formats in the future. Recommendations to incorporate educational materials with more explanatory illustrations were made to the PPWM Study research team.

Presentation: 25 minutes

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Alexandra LambertExamination of Non-Financial Barriers and Stigma for Mental Health Carehttp://jdc.jefferson.edu/mphcapstone_presentation/125
http://jdc.jefferson.edu/mphcapstone_presentation/125Mon, 07 Jul 2014 10:57:33 PDT
Mental illness is a significant issue in the United States, with 1 out of 4 adults suffering from mental health illness. While mental illness is generally thought to be influenced by sociobeconomic status and/or lifestyle choices, affluent communities with ample resources have a large number of untreated patients with diagnosed mental illness. This study queried both patients and physicians in Bucks County, an affluent suburban region within the greater Philadelphia area, to determine common attitudes and beliefs about mental illness, as well as identify barriers to care. Survey data was analyzed for patterns and trends using the SPSS statistical package. Results demonstrate that, while physicians report screening for and discussing mental illness with patients, community members express common barriers to care, such as time and cost. These issues are not discussed by healthcare providers, many of which can be addressed in the community. Overall study findings suggest that while physicians may be following generally recommended screening guidelines, they may not be adequately informed regarding barriers to care or pursuing these issues with their patients. Patients may be refusing or not understanding the importance of mental health care, and therefore not seeking treatment or dropping out of treatment too early due to time and cost issues.

Presentation: 25 minutes (Audio starts one minute into the presentation. Entire slide set is available at bottom of page)

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Jessica LevySuper Utilizers have more Adverse Childhood Experiences (ACEs)http://jdc.jefferson.edu/mphcapstone_presentation/124
http://jdc.jefferson.edu/mphcapstone_presentation/124Mon, 30 Jun 2014 12:56:57 PDT
This study characterizes the small group of patients who account for a disproportionate share of health care expenditures, known as ‘super utilizers’, who have multiple Emergency Department visits and hospitalizations. This cross-sectional study compared a super utilizer sample to normative data on measures of adverse childhood experiences (ACEs), general self-efficacy, and resilience (n=23). Results indicated that the super utilizers’ scores for resilience and self-efficacy were comparable to those in normative samples, but that these individuals experienced a higher burden of ACEs than the general population. Within the super utilizer sample, 48% experienced 4 or more ACEs, and 83% experienced at least 1 ACE. This is significantly above baseline population prevalence; in the normative data 6.2% experienced 4 or more ACEs and 52% experienced at least 1 ACE (p

Presentation: 12 minutes

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Aileen ZimmermanIdentifying Risk Factors of Hospital Admission during the Postpartum Period: A Cross Sectional Study of the 2010 Nationwide Inpatient Samplehttp://jdc.jefferson.edu/mphcapstone_presentation/123
http://jdc.jefferson.edu/mphcapstone_presentation/123Mon, 30 Jun 2014 12:51:29 PDT
Postpartum admissions occur when clinical illness, prior to the traditional six-week follow-up visit, results in being admitted to the hospital for acute care. Currently there is limited data that examine morbidity in this population in detail. The purpose of this Capstone project was to address the gap in knowledge regarding risk factors associated with postpartum hospital admission. A secondary data analysis was conducted using the Healthcare Cost and Utilization Project (HCUP)’s 2010 Nationwide Inpatient Sample. Relevant variables tested included age, race, primary insurance payer, number of chronic conditions, elective vs. non-elective admission, and primary diagnosis. Descriptive statistics, including frequencies, ranges, means, and standard deviations were calculated in order to develop an epidemiologic profile of the sample population. Associations of categorical variables were assessed using Pearson’s Chi-square test. There were statistically significant differences in non-postpartum obstetrical admission and postpartum admission across all variables studied. The most common primary diagnoses in women with a postpartum admission were hypertension, infection, and wound complications. Medicaid was the most common primary insurance payer for postpartum admission, followed by private insurance, and self-pay. Women ages 35-44 and African-American women had a proportionally higher rate of postpartum admission than non-postpartum obstetrical admission. Future public health research priorities and interventions will be discussed that aim to lower the number of postpartum admissions and improve quality of care through patient education.

Presentation: 17 minutes

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Manasi VinodAssessment of Health Policy Literacy Curricula in Physician Assistant Programshttp://jdc.jefferson.edu/mphcapstone_presentation/122
http://jdc.jefferson.edu/mphcapstone_presentation/122Mon, 30 Jun 2014 12:46:31 PDT
Health literacy is a growing concern in the United States today. The purpose of this study was to identify the current practices and curriculum content incorporated into physician assistant (PA) programs in the Northeast region of the United States. It also aimed to identify opportunities and methods to enhance health literacy in PA curricula. With the number of people with limited health literacy in the millions, it is vital that today’s health care force be educated in ways to identify and address limited health literacy. The physician assistant plays a pivotal role in the care of patients, and thus must receive the proper training to identify and address limited health literacy. An assessment of current practices of physician assistant training programs related to the inclusion of health literacy in the curriculum was completed through a survey of ten Physician Assistant programs located within the Northeast region of the United States. The study identified opportunities and a need to include health literacy education in the physician assistant education. Overall, the schools revealed that health literacy is included at least partially in the specific curricula. A majority of the programs include information regarding increasing awareness of the health literacy problem, oral communication, and written communication, as a portion of their respective health literacy training, while web page usability, and communication techniques such as Teach Back and Ask Me 3, were not incorporated. None of the ten schools identified a stand-alone course for health literacy training, but rather incorporate the topic into courses such as Professional Practice, Medical Interview and Counseling Skills, Underserved Populations, etc. Only a small fraction of curriculum is devoted to health literacy training in the PA programs, with an average amount of time being 3.3 total hours. While many of the schools identified health literacy as a “common sense problem”, the need for training is apparent. With various methods of training from lectures to review after rotations, the physician assistant as a mid-level medical practitioner must be knowledgeable about communication methods and understanding of the patient in order to be an effective caregiver. The data gathered through this survey shows a further need for health literacy training of future physician assistants, as well as a recommendation for the creation of a toolkit by the Physician Assistant Education Association (PAEA) based off of the American Medical Association (AMA) toolkit, and the inclusion of health literacy as a core competency of physician assistant education.

Presentation: 26 minutes

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Kristen CellaryThe Factors that Affect Fruit and Vegetable Consumption among Residents in Urban Food Desertshttp://jdc.jefferson.edu/mphcapstone_presentation/121
http://jdc.jefferson.edu/mphcapstone_presentation/121Mon, 30 Jun 2014 12:43:00 PDT
Food deserts are generally defined as areas of high poverty and low access to large grocery stores or supermarkets. Previous qualitative studies have focused on shoppers’ perceptions when purchasing fruits and vegetables, and the results show that the relationships between these multiple factors are complex. The purpose of this study is to quantitatively analyze the relationship between household and food environment characteristics, and fruit and vegetable consumption among residents of urban food deserts (N = 685). A multiple regression analysis was conducted to predict fruit and vegetable consumption from participant age, number of working household vehicles, and participants’ perceptions of food price, food quality, store quality and store safety. The full regression model was not statistically significant and the total variance explained by the model as a whole was 1.3%, F(6, 616) = 1.34, p = 0.238. Only two variables, store safety (β = -0.170, p = 0.009) and store quality (β = 0.139, p = 0.042), made unique statistically significant contributions to the model and they are strongly correlated (0.773, p < 0.05). Unlike previous studies which linked participants’ concerns about personal safety with their willingness to visit certain establishments, this analysis found an inverse relationship between store safety, and fruit and vegetable consumption. As participants felt safer traveling to their neighborhood store, their fruit and vegetable consumption tended to decrease. This study also found that as store quality increased, fruit and vegetable consumption increased as well, which is supported by previous work.

Presentation: 18 minutes

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Katherine PuskarzAn Assessment of Tobacco Cessation Protocol at an Urban Department of Oral and Maxillofacial Surgeryhttp://jdc.jefferson.edu/mphcapstone_presentation/120
http://jdc.jefferson.edu/mphcapstone_presentation/120Mon, 30 Jun 2014 12:38:38 PDT
Tobacco use remains one of the leading causes of preventable disease across the nation and is often attributable to negative oral health outcomes. Studies have demonstrated that dental settings offer effective platforms for implementation of tobacco cessation programs. Using an urban university’s Department of Oral and Maxillofacial Surgery, this project sought to evaluate the extent to which tobacco cessation counseling, education, and resources were provided and documented during patient visits. The goal of this project was to compare the tobacco cessation protocol used to the national guidelines supported by the American Dental Association and outlined by the Centers for Disease Control and Prevention. The Best Practices for Comprehensive Tobacco Cessation Control Programs advocate provider use of the 5 A’s when treating tobacco-using patients, which consist of the following: Ask each patient about tobacco-use at each visit, Advise tobacco-using patients to quit, Assess tobacco-using patients’ interest in quitting, Assist tobacco-using patients through counseling, prescription of medication, and setting a target quit date, Arrange for follow-up. This study examined patient records from August 2013 to March 2014, and selected current and former tobacco-using patients. Clinician interviews were performed to determine if tobacco cessation education/counseling documentation accurately reflects Departmental clinical procedure. After collecting 270 tobacco-using patient records, tobacco cessation education/counseling were fully documented in only 19 instances, representing just 7 percent of the total tobacco-using patients sampled. From the information gathered during the interview process, it was determined that tobacco intervention documentation practices do not accurately reflect clinician treatment behavior, and improvements in documentation practice will enhance Departmental cessation protocol. It is recommended that the Department enhance the quantity and quality of tobacco cessation intervention documentation to bring Departmental protocol in line with Best Practice guidelines.

Presentation: 24 minutes

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John M. McCullumA First-Degree Family History of Alcoholism: Effects on Clinical and Psychosocial Variableshttp://jdc.jefferson.edu/mphcapstone_presentation/119
http://jdc.jefferson.edu/mphcapstone_presentation/119Mon, 30 Jun 2014 12:35:19 PDT
Alcohol dependence or alcoholism is a serious public health issue. According to the CDC, alcoholism is responsible for nearly 88,000 deaths every year in the U.S.

In order to create and optimize prevention programs for alcohol dependence, it is important to understand factors that may increase the underlying risk and amplify its associated comorbidities. One such risk factor for alcoholism is a family history (FH) of alcoholism with the heritability estimates ranging from 50 to 60%. Alcoholism has been linked to higher numbers of psychosocial problems, low motivation to quit and disturbed sleep. The purpose of the study is to evaluate the role of a first-degree FH of alcohol dependence as a moderating factor on alcohol consumption, psychosocial problems, the subject’s motivation for change, and their habitual sleep duration. The study involved a secondary data analysis of baseline data obtained from an alcohol treatment interventional study conducted at the University of Pennsylvania Health System. The results demonstrated that a FH+ status was associated with a higher number of drinking days, as compared to FH- subjects. Interestingly, a first-degree family history of alcohol dependence was inversely associated with a lower proportion of days of heavy drinking (OR=0.30, p=0.04), number of drinks per drinking day, (OR=0.93, p=0.009), and sleep duration (OR=0.81, p=0.03). Lower proportion days of heavy drinking (PDHD) and lower sleep duration predicted a higher probability of having a first-degree family history of any other substance abuse disorder. In conclusion, a positive family history status was associated with a sustained higher number of total drinking days and lower number of drinks per drinking days.

Presentation: 22 minutes

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Swarnalata DebbarmaA Quantitative Evaluation of Prior Clinic Care on Prenatal Enrollment in a Medicaid-Subsidized Populationhttp://jdc.jefferson.edu/mphcapstone_presentation/118
http://jdc.jefferson.edu/mphcapstone_presentation/118Mon, 30 Jun 2014 12:29:41 PDT
The purpose of the project is to evaluate a Medicaid-insured prenatal population to quantify if pre-pregnancy encounters with our clinic promoted an earlier first trimester enrollment for the first prenatal visit, and also to measure number of prenatal visits that meet the definition of adequate care. A retrospective cohort study of an urban prenatal population with > 90% Medicaid-subsidized insurance was conducted. Women receiving prenatal care at a single institution were divided into two cohorts based on either prior clinic care or no prior clinic care. Primary data was collected for prenatal patients seen initially from Jan 1, 2013 to Dec 31, 2013. Primary outcomes included gestational age at first prenatal visit and number of total visits. Demographics included: level of education completed, spouse or partner involvement, race/ethnicity and prior mode of delivery for multiparous mothers. There was a statistically significant difference between the two cohorts in the gestational age at first prenatal visit. The t-test = .021. Cohort 1, with previous clinic care, (n=110) were first seen at 11.7 weeks gestational age. Cohort 2, without clinic care, (n=86) were first seen at 13.5 weeks (p=0.024). When stratified based on parity, the gestational ages were also statistically significant (p=0.004). Average number of prenatal visits for those seen previously was 10.4 visits for Cohort 1 and 10.0 visits for Cohort 2. (p=.21) Utilizing the Adequacy of Prenatal Care Index (APNCU) as another measure of prenatal utilization, showed a difference in the two Cohorts (65% vs. 58%) that was not statistically significant (p=0.44). Demographic variables were not statistically significant but clinically relevant differences were seen that might guide future research. Medicaid-subsidized insurance patients receiving care in the clinic prior to pregnancy were statistically more likely to enroll in prenatal care earlier in the first trimester than those without prior care. There was no difference in total number of visits between the cohorts. Non-traditional methods for enrolling patients in prenatal care should be considered.

Presentation: 31 minutes

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Cheung KimA Comparative Policy Analysis: Medicaid as a Payer for Maternity Care Serviceshttp://jdc.jefferson.edu/mphcapstone_presentation/117
http://jdc.jefferson.edu/mphcapstone_presentation/117Mon, 30 Jun 2014 12:25:42 PDT
Medicaid is a principal payer for maternity services in many states across the country. This study examines the importance of Medicaid as a payer for maternity care through a comparative analysis of the Medicaid policies and birth outcomes of four states: Georgia, Illinois, New York and Pennsylvania. Mixed methods were used to examine and compare policy and outcome variables in each state. Study results demonstrate that low-income women are not receiving proper preconception and interconception care. Preconception and interconception care are particularly important, as the majority of Medicaid pregnancies in the states studied were unintended. Additionally, between 21% and 33% of women received late or no prenatal care. The policy data collected found that many of the Medicaid policies across the states are the similar, but utilization of services, such as prenatal care, is not the same. This study also found that there is a significant lack of data, especially quality outcomes data. Outcomes data was not collected by the Centers for Medicare and Medicaid Services, nor was it uniformly collected across the states. Only two out of the four states actually tracked birth outcomes in the Medicaid population. Outcomes data needs to be collected for the Medicaid population to ensure that the policies are having a positive impact on women. This study recommends that states be required to submit reports on Medicaid policies and birth outcomes and that these reports be shared with all states. The rates of preconception and interconception care and other outcome measures should also be studied after the implementation of the Affordable Care Act to see if low-income women experience improvements in care.

Presentation: 19 minutes

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Alison SpanierA Quantitative Assessment on Hand Hygiene Adherence Among Patients Admitted to Thomas Jefferson University Hospitalhttp://jdc.jefferson.edu/mphcapstone_presentation/116
http://jdc.jefferson.edu/mphcapstone_presentation/116Mon, 07 Apr 2014 11:08:02 PDT
Hand washing is considered the single-most important practice in hospitals that reduce likelihood of acquiring/transferring infections. In March 2014, two Purell® hand wipes were added to the meal trays of patients to perform hand hygiene before and after consuming their meals. The purpose of this Capstone project was to evaluate the baseline state of patient hand hygiene adherence. Once newly implemented Purell® wipes were placed onto patient meal trays, a post intervention analysis was completed. Pre and post intervention surveys were distributed to patients on four inpatient units identified by the TJUH Department of Infection Control. The aims were to understand and increase patient hand hygiene adherence. The surveys also requested what types of hand sanitizing products were being utilized for those who were performing hand hygiene prior to and after consuming meals. For those patients who chose not to perform hand hygiene, the survey requested rationale from a patient perspective. The data was used to conduct a quantitative assessment by identifying the advantages and improvements of one test of change made in the units surveyed. Prior to the implementation of wipes, hand hygiene adherence was a major issue for patients who did not have access to the resources they needed to perform hand hygiene. Other reasons included, patients forgot to perform hand hygiene, or did not consider the importance of washing their hands which may lead to the spread of germs, a hospital acquired infection and increased healthcare costs. Looking at hand hygiene from a public health perspective, it appears that people assume hospitals are a safe, germ free environment and are not at susceptible to germs. The hand sanitizing wipe implementation has led to heightened awareness and an increase in the performance of hand hygiene by TJUH patients.

The purpose of this study was to assess the collaborative process of the St. Elizabeth’s Wellness Collaborative (SEWC), and to identify any areas where the process could work better. The SEWC is a coalition of 6 organizations aimed at addressing the behavioral and physical healthcare needs of the St. Elizabeth’s/Diamond Street community in North Philadelphia. The Partnership Self-Assessment Tool (PSAT) is a 67 item survey which measures partnership functioning, and has been demonstrated to be valid and reliable. The survey measures strengths and weaknesses in partnership synergy, leadership, efficiency, administration & management, sufficiency of resources, partner participation, and partner satisfaction. The PSAT was distributed to a member of each of the 6 participating organizations, and anonymous results were analyzed according to instructions given with the PSAT. Of the 6 surveys distributed, 4 were completed. The SEWC scored well in all areas except sufficiency of financial resources, where results indicated that more effort was needed to maximize the partnership’s collaborative potential. Other areas for improvement that were identified include obtaining support from entities in the community that can affect the partnership’s plans, carrying out activities that connect multiple services, preparing materials that help partners make timely decisions, and potential conflicts between partners’ jobs and the partnership’s work. Results of the survey will be presented to SEWC leadership to help identify next steps in improving the coalition’s functioning.

Presentation: 17 minutes

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Alex BryanAn Analysis of Energy Balance Knowledge, Behaviors, and BMI among Adolescent SNAP-Ed Participants in The School District of Philadelphiahttp://jdc.jefferson.edu/mphcapstone_presentation/114
http://jdc.jefferson.edu/mphcapstone_presentation/114Mon, 07 Apr 2014 10:35:24 PDT
Understanding the concept of energy balance (i.e., calories in = calories out) forms the basis of how to maintain a healthy weight through diet and physical activity. There is limited evidence that an energy balance-focused SNAP-Ed nutrition education program effectively impacts the energy balance knowledge (EBK) and behaviors of Philadelphia middle school students, and how those behaviors affect body mass index (BMI). This study aimed to further understand how low-income urban adolescents’ basic knowledge of metabolic energy balance is associated with their health behaviors, and how such behaviors are linked to weight status. A secondary data analysis was conducted using data from the School District of Philadelphia to examine relationships between students’ energy balance knowledge levels and energy balance behaviors, and their behaviors and BMI. Students’ baseline EBK level was negatively associated with SSB consumption (p<0.001). Baseline EBK and energy intake knowledge were significant predictors of SSB consumption. Baseline EBK was not associated with fruit and vegetable, milk or breakfast consumption, or with physical activity. EBK level was associated with, but not a significant predictor of breakfast, fruit and vegetable consumption, or physical activity among students who participated in the curriculum. Breakfast consumption was significantly linked to weight status; students who did not eat breakfast were about 2 times more likely to be overweight/obese than those who ate breakfast. The results showed that students lack basic understanding of metabolic energy balance, even after exposure to a nutrition education curriculum focused on the topic. Knowledge is necessary but not sufficient for behavior change to occur. Policy and system changes that address individual, social and environmental behavior influences, like structured recess, farm to school programs, and healthy eating policies in schools, could better improve adolescents' health behavior.